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'1" I. <br /> V SAN Jt)WUIN COUNTYPUBLIC HEALTH SEES �h�Jli�l" 1'!/LSU <br /> VIRONMENTAL HEALTH DIVISION <br /> 304 EAST WEBER AVENUE,THIRD FLOOR JAN 0 2 2001 <br /> STOCKTON CA 95202 t <br /> (2091468-3420 NVIRONPdIEN f HEALTH <br /> PUBLIC RECORDS RELEASE APPLICATION PERMIT/SERVICES <br /> APPLICANT '� � � � _BUSINESSIAGENCY '�.`nV i 1'av�tYlP ''a1eygo-fig7Kiodes <br /> ADDREss- ��Y1��PSS��+n �V Yl P -��}2 � �CrarnEvu�at CA 6157L S _ <br /> PHONE C-1IU/1, (�L�- SOC1 FACSIMILE (q(.(0) fj4o4 -4501 • <br /> TENTATIVE"APPOINTMENT DATE Sofa \O,aaa l TIME 9.30 Ary\ <br /> (Plr43e give 7O0 10 business daJ3 from dale of application submittal) <br /> CHECK BOX TO EXPEDITE REQUEST-/$87,,00'FEE- <br /> REQUEST PROCESSED IN 3 BUSINESS DAYS <br /> SIGNATURE OF APPLICANT �Gt DATE tiLA I( <br /> FILE ADDRESS •��-_ THIS SIDE END STAFF USE ONLY <br /> _ PROGRAM ELEMENTS SEARCII <br /> Mend c1r1D Avenwe <br /> .. <br /> S-lvdo-Ian <br /> --- •_ ckt -fact-f i .. � � �, � •r Y Ccw�{�cNt <br /> --- - <br /> S <br /> JAN -4 2001 ENVIRONNI <br /> UNDERGROUND TANK(USTI CLEANUP SITE(LOP) t +° -ys ` s ` <br /> cz <br /> ❑ OTHER CLEANUP SITE(NON-LOP) l y WQi <br /> UNDERGROUND TANK(MONB'ORINGIREMOVALI [ v • O��. <br /> ❑ HAZARDOUS WASTE GENERATOR �� .� rw <br /> ❑ TIERED OUS WASTE GENER _ <br /> ❑ TATTOOIBODYPEIRCING C 4 I 1 y�4 ,r� %''�' 111"• '� <br /> ❑ MEDICAL WASTE FACILITY <br /> 1. List up to ten addresses to the space -- "' <br /> the appropriate box(es). At least on, <br /> address Indicated above. - <br /> 2. EHD will notify the applicant If any C 01(,/, <br /> approximately five business days bu <br /> will be held for a maximum of five h s"1 <br /> accordingly. <br /> 3. file that is actively being worked a: <br /> a a� J TJ� <br /> application may be submitted when • "� "' <br /> 4. Any file not returned in the same cor ; <br /> of the applicant. Future file reviews <br /> 5. "TENTATIVE appointment dates mu v, <br /> 6. Applications received after 3:00 pm <br /> CONFIRMED APPOINTMENT DATE <br /> DATE CONFIRMED <br /> REVIEWED YES NO Mfr <br /> EH o0 1 00=700 "— <br /> L <br /> i <br /> Y 0 <br />